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Current Topics in Menopause, 2013, 315-325 315
Adnexal Mass and Ovarian Cancer in Menopause
Tanja Pejovic 1,* and Farr Nezhat 2
CHAPTER 11
1 Oregon Health & Science University, Portland, Oregon, USA and 2 St Luke’s -
Roosevelt Medical Center and Columbia University, New York, NY, USA
Abstract: The differential diagnosis of the adnexal mass indeed varies with the age.
Age is the most important factor in determining the potential for malignancy. In
postmenopausal women, an adnexal mass should be considered highly abnormal and
must be promptly evaluated. The risk of malignancy in this age group is increased from
13% in premenopausal to 45% in postmenopausal women, however 55% of
postmenopausal women with palpable ovaries do have a benign tumor. The most
common ovarian tumors in this age group include epithelial ovarian tumors followed by
stromal tumors and sex-cord tumors. The standard operative approach to adnexal
masses in postmenopausal women has been explorative laparotomy to ensure adequate
exposure for the treatment of ovarian cancer. However, laparoscopic evaluation of
suspicious adnexal masses is considered a reasonable approach with ability to perform
frozen section histologic analysis and confirm to laparotomy if needed.
Keywords: Menopause, Ovarian Cancer, Ovarian Surface Epithelium, Adnexal
Mass, Laparoscopy, CA125, Endometriosis.
ORIGINS OF EPITHELIAL OVARIAN CANCER
Epithelial ovarian cancer arises primarily from the ovarian surface epithelium
(OSE), with a subset possibly originating in the adjacent fimbria [1, 2]. The OSE
forms a monolayer of cells surrounding the ovary. Developmentally it derives from
the celomic epithelium that also gives rise to the peritoneal mesothelium and
oviductal epithelium [3]. The OSE appears generally stable, uniform and quiescent,
though it has potential of undergoing proliferation in vivo [4, 5]. No physiological
role for the human or non-human primate OSE has been established [6].
The search to identify epithelial precursors in the human ovary has proven only
partially fruitful. Histologic findings consistent with a preinvasive lesion for
*Address correspondence to Tanja Pejovic: Oregon Health & Science University, Portland, Oregon, USA;
Tel: 1-503-494-0111; Fax: 503-494-1835; E-mail: pejovict@ohsu.edu
Volodymyr Dvornyk (Ed)
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